Read Maryland Health Care Provider Sentenced to 10 years in Federal Prison for Health Care Fraud Resulting in Patient Deaths from the United States Attorney’s Office.
Use the 5 Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.
Write a 525- to 700-word paper that identifies and evaluates the root cause for Medicare fraud in this case.
Include the following:
- List each of the 5 Whys and your response.
- Speculate as to why Mr. Emeigh participated in the scheme.
- Explain what you might have done to prevent this from happening.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
Expert Solution Preview
Introduction:
The case of Maryland Health Care Provider, Timothy Emeigh, who was sentenced to 10 years in prison for health care fraud resulting in patient deaths, raises many questions about the root cause of Medicare fraud and Mr. Emeigh’s participation in the scheme. In this paper, we will conduct a root cause analysis using the 5 Whys method and evaluate the underlying reasons for Medicare fraud in this case. Additionally, we will speculate on why Mr. Emeigh participated in the scheme and suggest ways to prevent such incidents from occurring in the future.
Answer:
1. Why did the Medicare fraud occur?
The Medicare fraud occurred because the health care provider knowingly submitted fraudulent claims to Medicare for services that were not provided to patients. The provider falsely claimed that these patients had received medical services, including dialysis treatments, that were never provided. This resulted in financial losses for Medicare and put patients’ health at risk by increasing their risk of complications and even death.
2. Why did the health care provider knowingly submit fraudulent claims to Medicare?
The health care provider submitted fraudulent claims to Medicare to inflate bills and obtain higher reimbursements. They prioritized financial gain over the well-being of their patients and knowingly put patients’ health at risk to achieve financial gains.
3. Why did the provider prioritize financial gain over the well-being of their patients?
The health care provider prioritized financial gain over the well-being of their patients because of a lack of oversight, auditing, and accountability in the healthcare system. This lack of accountability allowed providers to exploit the system for their financial gain without fear of legal consequences.
4. Why did the healthcare system lack oversight, auditing, and accountability?
The healthcare system lacked oversight, auditing, and accountability due to a lack of resources, weak regulations, and insufficient penalties for noncompliance. Insufficient funding and resources led to a lack of oversight and auditing of healthcare providers, enabling them to exploit the system for their financial gain. Additionally, the penalties for noncompliance were not sufficient to deter fraud and abuse of the system.
5. Why did the lack of oversight and accountability persist in the healthcare system?
The lack of oversight and accountability persisted in the healthcare system due to a lack of political will and public pressure to address these issues. Political leaders did not prioritize or invest in healthcare system oversight and accountability, while the public did not demand accountability for healthcare providers.
Speculation on why Mr. Emeigh participated in the scheme:
It is possible that Mr. Emeigh participated in the scheme for financial gain. He may have been incentivized to submit fraudulent claims to Medicare to inflate bills and obtain higher reimbursements. It is also possible that he participated in the scheme due to a lack of oversight and accountability in the healthcare system. The lack of consequences for fraudulent behavior may have encouraged him to continue participating in the scheme.
Ways to prevent such incidents from happening in the future:
To prevent similar incidents from happening in the future, it is necessary to increase oversight and accountability in the healthcare system. This can be achieved by allocating more resources to healthcare system auditing and strengthening regulations to deter fraudulent behavior. Penalties for noncompliance should be increased to ensure accountability for healthcare providers who engage in fraudulent behavior. Additionally, public pressure and awareness can help hold healthcare providers accountable for their actions and promote ethical behavior in the industry.
References:
1. “Healthcare Compliance & Ethics News.” Health Care Compliance Association, www.hcca-info.org/.
2. “Medicare Fraud.” National Council on Aging, www.ncoa.org/center-for-benefits/medicare/medicare-fraud/.
3. “Healthcare Fraud.” U.S. Department of Justice, www.justice.gov/criminal-fraud/health-care-fraud.